Demands

Police Brutality: Police brutality is now a leading cause of death for young Black men in the US - higher than diabetes and influenza/respiratory infections. Yet these heinous acts of racism and the corresponding public health crisis are scarcely addressed in medical school curricula. Understanding the roots of police brutality - systemic racism, socioeconomic inequities, white supremacy - and how they impact the life and death of people of color should be at the forefront of our curriculum, as a longitudinal lens through which students view and understand the intersection of medicine and public health throughout all 4 years of training and beyond.

• ACTION #1: Add mandatory medical school curriculum on racism. We recommend that the medical school utilize and expand on existing curricula developed by UMN faculty of color, in addition to contributions from other faculty and students.

  • Course content should focus specifically on the history and foundations of health inequity, the sociology and epidemiology of systemic racism, white supremacy, and xenophobia in Minnesota and the United States, the mechanisms by which structural inequities affect our peers and patients, and the importance of trauma-informed care and cultural humility.

    • Example course content include: 1) Summer reading assignments on health inequity in medicine followed by facilitated small group discussion on Day 1 of medical school, 2) Administering the IDI (for which funding for faculty training has already been arranged) or other well-studied cultural humility assessment with an intentional developmental curriculum to all incoming first-year students so as to tailor health equity curriculum to individual needs throughout all four years, focusing on growth and competence as a community, 3) Enhanced ECM lectures & small groups that highlight the voices of community speakers and advocates, 4) FCT small groups & POCC didactics with more non-stereotypical and nuanced narratives on structural racism and trauma-informed care. Sample cases can be found here, here, and here.

  • Note: While an addendum to the curriculum is necessary, it is not sufficient. Anti-racist curriculm should be a part of all standard curriculum throughout all four years, and should be constantly surveyed, amended, and edited to maintain values of equity and inclusion. As such, funding and investment should be directed to establish an Associate Dean of Diversity & Education that interfaces with the Vice Dean of Diversity & Inclusion and the Associate Dean of Curriculum.

COVID-19: The 2019 coronavirus pandemic has disproportionately affected many communities of color. In Minnesota, non-white individuals comprise 31% of all confirmed positive cases as of May 29th 2020, while comprising only 15% of the state’s population.

• ACTION #2: Robust, mandatory infectious disease/epidemiology curriculum on the causes and effects of global & national pandemics. Offer joint coursework with colleagues at the School of Public Health aimed at educating future physicians with the necessary skills for disaster preparedness, in addition to the roles of race, racism, and unequal access to healthcare in infectious disease pandemics and their epidemiological interventions.

Campus-Wide Climate Survey: Undergraduate Medical Education has not yet engaged in a process to determine perceptions of inclusion, or assess organizational justice. Previous studies have shown that institutions that engage in robust climate and culture assessments are in a position to overcome barriers to diversity and inclusion and act on opportunities.

• ACTION #3: The Office of Undergraduate Medical Education should engage in routine (min. 1/semester) campus climate and culture assessments to determine whether the administration is meeting students needs for diversity and inclusion. This data must be anonymized, summarized, and reported directly to students so that administration and students can track progress and change side-by-side. Results from the assessments should be used, in addition to narrative assessments from student volunteers, to continue to reform and sustain necessary change regarding the campus culture of diversity and inclusion. These efforts should be spearheaded by the Vice Dean for Diversity and Inclusion, the Office of Student Affairs, and the Dean of Undergraduate Medical Education.

Understanding roots of systemic oppression and health inequity is important for students, but this knowledge is just as important of an asset for our educators, mentors, and administrators. Thus, it is critical for all faculty members to learn alongside students, not only to become better educators, but also to be able to partner with students and community members in driving change forward.

• ACTION #4: Create a curriculum for all faculty members, medical educators, and administrators beyond implicit bias training, aimed at establishing pedagogical methods to adequately teach topics of health equity and structural racism in medicine. Drawing from programs at peer institutions, such a curriculum should:

  • Implement training and mentorship modules with the goal of developing quality health equity curricula and didactic methods.

  • Engage in inter-professional partnerships across disciplines, institutions, and health care fields to advance health equity curriculum development and delivery.

  • Enhance funding, resources, and attention to pathways for recruitment, training and retention of underrepresented in medicine faculty.

In February 2016, an article published in Science stated that “racial categories are weak proxies for genetic diversity and need to be phased out.” These findings subsequently called on the U.S. National Academies of Sciences, Engineering and Medicine to put together a panel of experts to identify ways for researchers to shift away from the racial concept in research. Again, in 2019, fellow faculty members wrote, “Treating race as a proxy for genetics also actively harms Black, brown, and Indigenous communities. By treating race as biological, we place the blame of racial disparities on communities already suffering from racism and enforce the racist belief that these communities are genetically inferior.” Still, medicine and medical education continue to teach race-based medicine as part of the standard curriculum. These collective actions continue to perpetuate false narratives on race, blinding students to other social injustices responsible for the patterns in health outcomes otherwise falsely contributed to “race.”

• For example: In MS1 Physiology and many MS2 HHD blocks, hallmarks of race-based medicine such as formulae for calculating PFT, GFR, and anti-hypertensive medications can still be found in lectures that comprise core parts of the curriculum.

ACTION #5: Ongoing movements to phase out race-based medicine in medical practice and medical education (as seen most recently at the University of Washington) are occurring at other U.S. medical schools. We ask for the same to be done to all instances of race-based medicine currently included in our curriculum.

Our university is preparing us to become physicians that will serve the diverse communities of the Twin Cities, Minnesota, and beyond. As part of our medical training, it should be required, not optional, to have encounters with standardized patients who come from different paths than our own. These should not be limited only to patients of color, but include patients of different ages, genders, race, housing status, religion, sexual orientation, country of origin, ethnicity, and spoken language. Because of this, we are asking for the following:

ACTION #6: Increase funding and resources for recruitment of standardized patients from minority groups AND incorporate the use of interpreters into standardized patient encounters.

Note: Although Spanish is the second most-spoken language in our country, it is necessary to expand diversity efforts beyond solely Spanish interpreters to include simulated clinical interactions that reflect the communities and languages we will encounter throughout our clinical training (i.e., Somali, Hmong).

ACTION #7: Incorporate complex topics into clinical scenarios utilized in standardized patient interactions, OSCEs, POCC didactics, etc. to teach students how to navigate power dynamics, address stereotypes from providers/patients, and develop emotional regulation/slow thinking skills to overcome implicit bias.

Communities of color have long existed in Minneapolis, where Black neighborhoods date back to the 1930s. They confront public health issues and have a greater understanding of them. These resilient communities also have solutions and knowledge that medical students must have to fulfill our medical school diversity statement. We value their experiences and therefore they should be represented in our classroom.

• ACTION #8: The medical school should invest in amplifying and expanding existing cascading mentorship programs like The Ladder and to develop new programming promoting scientific scholarship among students of color within the community. Pipeline STEM programs provide an educational opportunity for youth, offer an equitable approach to underrepresentation in medicine, and address public health issues in partnership with the community. The University of Maryland Baltimore CURE program and Thread mentorship program are examples the University of Minnesota can learn from.

• ACTION #9: Medical school community engagement efforts should be mandatory, and implemented longitudinally. These should be created by the medical school, and not solely by the medical students who are invested in this, most of whom are underrepresented minorities. There are experts at the School of Public Health, Program in Health Disparities Research, Heritage Studies and Public History graduate program, Human Rights graduate program, and the African and African American Studies graduate program with whom we can partner to develop community engagement programming for medical students. Moreover, through community reconciliation discussions we could address the lack of trust in our institution. These initiatives would acknowledge our institutional history and understand community perspectives to move forward together.

• ACTION #10: Implicit bias training or other well-studied cultural humility assessment should be mandatory before initiating community outreach.

  • Note: Given limited information on which training is proven to be the most effective, we also hope to continue investigating the best evidence-based methods for ensuring anti-racism in community work.

• ACTION #11: Police brutality and misconduct has a traumatic impact on patients and providers of color. While we applaud the university’s recent decision to no longer contract with Minneapolis PD, problematic policing is not an isolated incident and affects our own UMN police. This in turn affects our community, students, and patients. Policies should be reviewed to prevent the profiling currently rampant on our campus, implicit bias training should be mandatory for all UMN police, and there should be clear policies regarding accountability and addressing complaints against officers. Furthermore, physicians and public health faculty should reside on a board to oversee UMN PD training, as well as establish inter-professional dialogue regarding incident reports, training, and bias.